The proposed project here aims to facilitate the use of laparoscopically mounted ultrasound transducers during minimally invasive surgical (MIS) procedures. During a standard laparoscopic procedure, the surgeon operates through small incisions in the abdomen while viewing the internal anatomy on a remote video monitor;this creates a significant spatial coordination problem involving the surgeon's vision, his hands and the laparoscopic instruments. Because of this, many injuries occur during MIS procedures. Intra-operative ultrasound could provide a more thorough understanding of the surgery area (and thereby decrease the risk of injury), but the surgeon must then view an additional video stream on a second monitor. This exacerbates the spatial coordination problem of conventional MIS;with laparoscopic ultrasound, the surgeon is imaging two different areas of tissue within the body, and anatomical features in one image do not correspond to the same features in the other. We offer a solution to this problem with the Registered Ultrasound-Endoscope (RUE). In this system, the ultrasound video is spatially registered to the laparoscopic video, and is superimposed over it in the correct location. In this way, the echographic image of the tissue will be aligned to its image in the laparoscope's view. By fusing the video imagery and the ultrasound imagery into a single, unified display, the RUE addresses the serious problems associated with laparoscopic ultrasound (a complex dual-monitor interface and a difficult spatial coordination problem). We expect this device to significantly increase the use of laparoscopic ultrasound, by making it easier and faster to use. In this Phase I project, we propose to develop a RUE prototype and test it both quantitatively and qualitatively. Building the prototype will require both hardware and software efforts. We will test the performance accuracy of the system, followed by two rounds of testing with our surgeon collaborator. The first round will allow us to optimize technological and ergonomic aspects of the device, while the second round will quantitatively assess the system's utility. If funded, we will propose a Phase II project that would include wider-scale testing in animal models and human subjects. We are focusing initially on laparoscopic cholecystectomy for deployment of the technology, but we are by no means limited to it;this system could be adapted to any procedure that would benefit from laparoscopic ultrasound. PUBLIC HEALTH RELEVANCE: We propose an advanced visualization system for minimally-invasive surgery (MIS) that facilitates the use of laparoscopic ultrasound, for targeted use during laparoscopic cholecystectomy in order to reduce the rate of injury to the bile duct. When realized, the proposed system will provide visual information to exceed even that which is currently available via either the laparoscopic or even traditional "open" (i.e. laparotomic) approach. It can be adapted to different procedures, and holds to potential to enable procedures that currently cannot be carried out via MIS to become MIS-amenable. Compared to the conventional laparotomic (or "open") approach, MIS procedures have been shown to reduce trauma, recovery time, length of hospital stay, hospital cost, blood loss, post-operative fever, and time until the patient is able to return to work.